Unveiling Barriers and Boosters: Assessing Reach and Access of the Integrated Management of Acute Malnutrition Programme in Jhapa District, Koshi Province, Nepal

Abstract

Background: Acute malnutrition is one of the leading underlying causes of
morbidity and mortality among children under 5 years of age. To address this issue,
Nepal Government introduced Integrated Management of Acute Malnutrition
(IMAM) programme. However, limited evidence on its coverage and accessibility
raises serious concerns about effectiveness of the programme. The study aimed
to identify the barriers and boosters affecting the programme coverage and to
estimate the programme coverage of Jhapa district along with developing the plan
of action for improving the programme interventions to increase coverage and
accessibility of the programme.
Methods: The study adopts a semi quantitative evaluation of access and coverage
(SQUEAC), a mixed method which combines routine programme data, qualitative
data through interviews and focus group discussions, direct observations and
small area surveys.
Results: The assessment identified 17 boosters and 24 barriers. The barriers
included poor coordination, outdated tools, poor record maintaining, lack of
refresher training, and low community awareness, while boosters included,
trained staff, effective counselling, and regular growth monitoring. Overall
coverage found to be 34.4%, with a confidence interval ranging from 23.2% to
47.9%. Point and period coverage calculations based on survey data revealed a
point coverage of 15.8% and a period coverage of 27.3%.
Conclusion: The IMAM programme in Jhapa shows the coverage is lower than
the global benchmarks indicating that the programme needs the intervention to
improve the systemic challenges for increasing the coverage and access.